Simon Harris (Wicklow, Fine Gael) | Oireachtas source

I thank Senator Burke for raising this issue for discussion today. I am taking this matter on behalf of my colleague, the Minister, Deputy Leo Varadkar, who is unable to be here due to Government business. Neural tube defects, NTDs, include a range of serious congenital malformations as a result of incomplete closure of the neural tube within a month of conception. They include anencephaly, which is not compatible with life, to the more common forms of spina bifida and other forms which can be symptom free. Approximately 80% of infants with spina bifida survive, however, the condition is associated with varying degrees of disability. These include a poor ability to walk, problems with bladder or bowel control and hydrocephalus.

The level of neural tube defects varies from 0.05 to six per 1,000 births, however, this can change from year to year and there are regional and country variations. Neural tube defects are believed to be due to a combination of genetic and environmental factors. If one child has the condition or if a parent has the condition there is an increased chance that the next child may also be affected. It is now considered that not having enough folate in pregnancy also plays a significant role. There is evidence that many cases of NTD are preventable if the mother increases her consumption of folic acid before and during the early days of pregnancy. There are a number of sources of folate. Folate is found naturally in green vegetables, fruit, dairy products, eggs, seafood and grains.This is recognised in the Department of Health's healthy eating guidelines which have been widely disseminated and are available on the Department's website. The guidelines are due to be reviewed again this year.

Folate is also available as folic acid supplements. It is recommended that the optimal dose for supplementary folic acid relating to pregnancy is 400 mg orally a day. The supplement is readily available in pharmacies throughout the country. However, clinicians also recognise that women at increased risk of NTDs should take a higher dose per day which requires a prescription. The third source of folate is food fortification. At present fortification is voluntary in Ireland and includes a range of food products.

While the level of NTDs has fallen considerably over recent years, there has been an increase in 2009 to 2011 where the level is now 1.17 per 1,000 births. This trend is under active review and may relate to better case detection, a reduction in food fortification levels or a reducing trend in folic acid supplementation among women booking for antenatal care. In recognition of this, safefood Ireland has recently awarded a research grant to conduct an all-Ireland study to measure red cell folate levels in women booking for antenatal care in Dublin, Cork and Belfast. In addition, the Food Safety Authority of Ireland is preparing a report for the Minister of Health on food fortification with folic acid.

The HSE has developed a guide called Healthy Eating For Pregnancy which includes the importance of taking folate to prevent spina bifida. There is further advice on the HSE's website.The Department of Health is reviewing its national guidance on folate for women of childbearing age.

In July, safefood will launch a campaign entitled Babies: Know the Facts about Folic Acid. The campaign will be targeted at younger women who may be sexually active but not considering pregnancy, women who are considering pregnancy and women who already have a child but may have become complacent about taking folic acid. The key message of the campaign is to stress the importance of getting into the routine of taking folic acid every day irrespective of whether a pregnancy is being planned. As the Senator has suggested, it is mainly a digital campaign that uses social media. However, traditional communication channels will also be employed. Key partners include the Department of Health and the HSE in the Republic, and the Public Health Agency and the Department of Health, Social Services and Public Safety in Northern Ireland, pharmacists, GPs and public health practitioners, as well as the support group for Spina Bifida Hydrocephalus Ireland.